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Biopsy Of The Roof Of The Mouth

New Mexico rates for HCPCS 42100

Takes a small piece of tissue from the roof of the mouth or from the uvula, the flap hanging at the back of the throat, so it can be examined under a microscope. Only a sample is taken and the rest of the area is left in place. It is done to find out what is behind a patch, sore, swelling or growth that has not settled on its own.

Rates data updated July 2026.

Facilitymedian $195 · 10th–90th $117$3,2360%10%20%10th90th$195Professionalmedian $148 · 10th–90th $105$2510%20%10th90th$148$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$2,137.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$251.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$2,818.38
Typical High
$4,570.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$162.18
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$169.82
Typical High
$257.04
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$204.17
Providence
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$281.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$3,235.94
Typical High
$5,248.07
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$173.78
Typical High
$269.15